amp of D50

Nursing Students Student Assist

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Hi everyone,

I have the following questions: If a person is hypoglycemic and unconscious, do you give an amp of D50 or 1mg of glucagon I'm in the ED? I also want to know what an amp actually means. How many mg/cc is an amp of D50 and how do you administer it in an emergency situation? Is it IV push or IV drip? If it is an IVP, over how many mins do you push? If it's an IV drip, for how long should it infuse into the pt?

Thank you in advance for your responses.

Thanks for the reply. I work for an infusion company that teaches IV classes. I talked to the educator yesterday and asked his opinon...he said in an emergency situation, you push the first half as fast as you can, which isn't that fast because of the viscosity, then he said at that point hopefully the patient becomes conscious and you push the 2nd half slowly. Interesting.

Maybe I'll become an IV nurse some day and become an expert on this!! haha :)

1 Votes
Specializes in Spinal Cord injuries, Emergency+EMS.
DeLanaHarvickWannabe said:
I checked out my health care system's formulary, and it agrees with this except in emergent use. Apparently in a continuous infusion, the 3mL/min maximum is appropriate. So no more than 180 mL/hour. (But dear heavens, I have never seen anything more than D10 given as a drip!)

My formulary also recommends central access, and doesn't have a maximum per minute push rate for emergent use. Ugh, that is annoying! I think formularies and drug guides are sometimes written by Martians...

none 'emergent' use of D50

D50 and insulin for hyperkalaemia anyone ?

drug guides are written by freaks - if you aren't meant to use smaller than a 10 ml syringe into IVs how can i give 10mg / ml Morphine sulphate or 100mg in 2 ml tramadol without diluting them to 1mg in 1ml or 10mg in 1ml respectively and still give slowly / titrate ...

NEVER EVER give IV tramadol neat it gets messy as your patient does their impression of something out of a horror movie projectile vomiting across the ward...

1 Votes
Specializes in NRP, FP-C, CCP-C, CCEMT-P.

Something you might look into is the use of D10 vs. D50 for hypoglycemia ( Journal of Emergency Primary Health Care ).

The use of D10 was found to be AS quick, as the use of D50 to correct hypoglycemia (8 minutes for both), with less side effects. The difference in osmolality is also huge (10% dextrose is about 220 mOsmol/L higher than serum, slightly less then twice, while 50% dextrose is about 2,235 mOsmol/L higher than serum, almost 9 times as high.)

DEXTROSE (DEXTROSE MONOHYDRATE) INJECTION, SOLUTION [bAXTER HEALTHCARE CORPORATION]

What I have been doing is removing 50ml from a 250ml bag of NSS & injecting the 25g of D50, thus creating D10 & then infusing it, rather then pushing it. Much easier to admin. this way & I also find that it generally results in less Dextrose needing to be admin. for an increase in mental status, AND also having less chance of "spiking" the pts. BG and having the rebound "fall" again.

1 Votes
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
LearningByMistakes said:
Something you might look into is the use of D10 vs. D50 for hypoglycemia ( Journal of Emergency Primary Health Care ).

The use of D10 was found to be AS quick, as the use of D50 to correct hypoglycemia (8 minutes for both), with less side effects. The difference in osmolality is also huge (10% dextrose is about 220 mOsmol/L higher than serum, slightly less then twice, while 50% dextrose is about 2,235 mOsmol/L higher than serum, almost 9 times as high.)

DEXTROSE (DEXTROSE MONOHYDRATE) INJECTION, SOLUTION [bAXTER HEALTHCARE CORPORATION]

What I have been doing is removing 50ml from a 250ml bag of NSS & injecting the 25g of D50, thus creating D10 & then infusing it, rather then pushing it. Much easier to admin. this way & I also find that it generally results in less Dextrose needing to be admin. for an increase in mental status, AND also having less chance of "spiking" the pts. BG and having the rebound "fall" again.

If this is approved by your hospitals formulary and it is not for the insulin/dextrose treatment for elevated K. The only time 50% dextrose need to be diluted is for peds/neonates. Although this thread is a year old there are some things always worth repeating.

1 Votes
Specializes in NRP, FP-C, CCP-C, CCEMT-P.

I think you might find D50 to be on it's way out. If the studies continue to show the same results, there is no advantage & MANY down sides to the use of D50, when D10 will do the same thing.

I do agree this is NOT for an elevated K.

Just something to be aware of. Do with this information as you please.

1 Votes

it may be helpful if you go review your old Chemistry text to remind yourself what a 50% solution is. this will help you remember why you give it and how much it is. one big reason why nursing students take Chemistry is so they know what d50w, 0.9%ns, and 3%ns are. among others.

1 Votes
Specializes in NRP, FP-C, CCP-C, CCEMT-P.

Perhaps you might want to read the articles, just presenting what CURRENT research is showing. AND mixing D50 in NSS to make D25/D10/etc. is an accepted practice.

1 Votes
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I have read the current research. These boards are looked at by all levels of nursing, including new grads. Just because something is current in the research, doesn't necessarily mean it has been passed/approved by the pharmacy and therapeutics at a particular facility for standards of practice.

What is acceptable at one facility is not accepted by another. Some facilities allow much move lateral input to allow the nurses to mix/administer within "acceptable" guidelines...some do not and are much stricter with procedure, especially outside of the critical care areas.

New grads need to remember that they need to do their own investigations and abide by their facilities policies and procedures for they are held accountable for their actions. They also need to remember that this is still an anonymous board and while most people are honest you never know who is on the other side of the keyboard.

1 Votes
Specializes in NRP, FP-C, CCP-C, CCEMT-P.

My mistake, I thought we were here to learn. I'm sure you read the research. Have a nice day.

1 Votes

I just had to give Glucagon tonight and directions in our kit says to give it subcutaneously. Just wondering if the IM route is an ED protocol?

1 Votes
Specializes in Emergency Department.
mediastone said:
I just had to give Glucagon tonight and directions in our kit says to give it subcutaneously. Just wondering if the IM route is an ED protocol?

Glucagon can be given subcutaneously, IM, or IV. I've always been instructed to give it IM because if there's an IV established, I'm going to push D10 or D50 for a low blood sugar level. It could very well be that the equipment in the kit is setup only for subcutaneous administration, thus the instruction to give it that way. Onset might be a little slower with that route vs IM, but it should work.

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